Introduction
The code of ethics is a set of values meant to govern and guide nurses in their day-to-day duties when they care for patients. The code ensures that the patients’ interests are factored in during the provision of health care. The nursing code of ethics respects human life and enhances survival. This paper applies the code of ethics in a selected case study as a way of enhancing one’s understanding of this code.
Case Study
Mr. Wilkinson is an elderly, 77 years old man, who lives with his wife and son. He is at the end-of-life stage. He has lung cancer with secondary liver cancer. The fact that he has lost a lot of weight indicates that his condition has become worse. At this point, it is strongly felt that Mr. Wilkinson ought to be admitted and assessed. The pain he is experiencing needs to be taken under strict control.
He is taking co-codamol at the moment to help in alleviating his pain but the nurses advise that morphine would be a better alternative for him. Mr. Wilkinson, however, has refused to take morphine because he knows lots of stories connected with morphine and people’s experiences with it.
The ward staff cares a lot about Mr. Wilkinson since he is feeling a lot of pain. However, to avoid an intake of morphine, he says that everything is fine with him. Mr. Wilkinson tells the nurses that everything is destined and that God would take him when his time comes. He, therefore, does not wish to be drugged to death.
His condition becomes worse within one-week time. He is literally fighting for dear life in his semi-conscious state. He is irritable when conscious and sometimes screams when being moved.
The nurses are distressed and find themselves in a dilemma. The wife and son have seconded Mr. Wilkinson’s opinion of refusing morphine. Later on, the son changes his mind, and he appears to hesitate about his father’s decision against morphine
The consultant and nursing staff are sure that morphine is the best option for the patient in the given case to calm down the pain. On the other hand, the junior doctor and staff feel that they have to respect Mr. Wilkinson’s wishes regardless of his debilitating state (Dow, 2007).
Application of Code of Nursing Ethics
The case above represents a situation where the health workers are in a dilemma, in particular, to give morphine to the patient or not. A look at the professional nursing code of ethics will help in analyzing the situation and seeking a way out of the situation. The first provision of the code of ethics stipulates that the nurse should uphold compassion and respect for every individual regardless of their status or personality (Gamble, 2009). The nurses, therefore, should respect the patient, those related to the patient, and their own colleagues. This principle can be very tricky especially in the case of Mr. Wilkinson which can be regarded as a contradictory one. The nursing staff show respect for Mr. Wilkinson’s wish to refuse to take in morphine. Respect for human dignity with regard to the decisions they make should, however, be autonomous. It should not be based on other people’s opinions as is the case of Mr. Wilkinson. In the case outlined above, it is not shown how the providers deliver accurate, complete and comprehensible information to the patient or his family. The providers have their desirable options but they fail to assist Mr. Wilkinson to weigh the pros and cons of using morphine from a medical point of view. Mr. Wilkinson’s decision not to take morphine, consequently, is not self-determined.
In the case of Mr. Wilkinson, his refusal to take morphine is not autonomous, hence, an alternative must be sought. Autonomy is the ability of a person to make an independent decision without being forced or influenced. The family is in most cases is regarded as the patient surrogate, but if a power of attorney is present, the designated person makes a decision on behalf of the patient. According to section 1.2 of the nursing code of ethics, respecting a person’s wish does not necessarily mean that the nurse condones the choices made. The nurses should try to reason out with the patients or their surrogates. If this fails totally, it is only then that the nurse is left with no option but to fulfil the patient’s or relatives’ wishes regardless of the possible outcome.
Since Mr. Wilkinson is in a semi-conscious state and his conscious state does not give him the chance to make wise decisions, the family prevails if one needs to make decisions. The family respects the uninformed choice of Mr. Wilkinson but the providers fail to educate them on the desired way out. It is eminent that the nurses want the best for Mr. Wilkinson, respect him and even though he is dying, they want to alleviate his suffering. It is also evident that the nurses respect each other’s opinions hence the dilemma appears. The senior providers respect the concerns of the junior providers in the fact that morphine cannot be administered without a mutual agreement of all the staff.
The second provision of the nursing code of ethics is that the nursing staff should be committed to the patient, be it an individual or group (Gamble, 2009). This is evident in the case above because the wishes of Mr. Wilkinson and his family to withhold the use of morphine have been met. The nurses should act in a way that ensures the safety of patients and safeguards their interests while upholding integrity. The care to be administered to the patients should encompass the uniqueness of the patient, so, in order to achieve this, planning of care should include the patient. Not delivering morphine does not ensure safety although it safeguards the interests of the patients. To some extent, however, failure to give morphine does not safeguard the interests of the patient because the patient’s decision is not self-determined. Consulting the family’s opinion is in accordance with the three models discussed by Scott (2009). The three models are applicable in an end-of-life situation, where the patient does not have the capacity to make a decision.
The three models discussed are very important in making health care decisions. The first model dictates that the health care provider makes the decision, which should have the patient’s best interests at heart. This is in-line with the ethical principles of nursing where beneficence and nonmaleficence are its parts. In such a case, the patient, family, or other caregivers cannot question the doctor’s decision. This model is useful because patients will not always agree with the provider’s decisions (Scott, 2009). The second one entails decisions made by the patient and family members. Unfortunately, this model exposes the patient to poor choices. Neither the patient nor the family are medical professionals. Therefore, they cannot solely make decisions pertaining to the treatment of the patient. The ethical principles entailed in the nursing code of conduct govern the decision-making process of the providers because the decisions made should be aimed at alleviating suffering, promoting and restoring the health of individuals.
The third model is collaborative and combines both the patient’s personal values and beliefs with clinical knowledge and experience to come up with the best decision. The nurses should work collaboratively with other individuals or groups to ensure that the health needs of patients are met. In the case presented above, it is implied that a multi-disciplinary approach has been used to meet the needs of Mr. Wilkinson. Both the junior and senior doctors and nurses are working together to ensure that the needs of Mr. Wilkinson are met.
Since the nurse is charged with the responsibility of ensuring that the patients receive the very best, he or she is required to follow and advocate for the patient’s informed choice. In the case of Mr. Wilkinson, the nursing staff cannot advocate for his decision because it was not objective. On the contrary, if the decision would have been objective, the health care providers would have been left with no choice but to follow the wishes of the patient regardless of the conflict with their own opinions.
Way Forward
To begin with, the choice of Mr. Wilkinson is influenced by other people’s choices but not because he has been informed about it. Since at the moment he does not have the capacity to make decisions, the health care providers should give accurate and comprehensible information to his wife and son to make an informed choice on behalf of Mr. Wilkinson. It is only after that they make an informed choice that the team should accept the ultimatum. The health care team should play its part very well as stipulated by the code of ethics and leave the rest to the patient and his family.
References
Dow, L. (2007). Advanced Statements Contextualised Scenario. Web.
Gamble, M. A. (2009). Nurses: Caught in the middle of tough decisions. Minnesota Nursing Accent, 80, 14-25.
Scott, M. (2009). Decisions, Decisions, Decisions: Do you know your role in advance directives? Minnesota Nursing Accent, 83, 28-29.